Remote Bone Health Service for Osteoporosis Screening in High-Risk Men: A Cluster Randomized Clinical Trial
Abstract
Importance: Evidence supporting osteoporosis screening in men is limited. Efficient models that promote osteoporosis screening and adherence in primary care are needed.
Objective: To test the impact of a centralized, remote bone health service (BHS) on screening, treatment, adherence, and bone density in older men with fracture risk factors.
Design, setting, and participants: This cluster randomized clinical trial involved 39 primary care teams in 2 Veterans Affairs (VA) Health Systems that included 3112 male veterans aged 65 to 85 years who had at least 1 fracture risk factor but had no prior fractures. Data were analyzed from July through November 2025.
Intervention: Eligible men in medical teams randomized to BHS were invited to undergo dual-energy x-ray absorptiometry (DXA) scan, followed by an electronic consult to their primary care clinician with additional recommendations. A nurse care manager entered orders, obtained test results, provided patient education, and monitored adherence over the phone. Primary care teams randomized to usual care received osteoporosis education and VA practice guidelines.
Main outcomes and measures: DXA screening rates, osteoporosis treatment, persistence, and adherence were compared between patients in BHS and usual care. A random subset of patients in each team had a DXA 24 months after team enrollment, regardless of whether they had been screened during the intervention.
Results: Of the 3112 randomized participants (mean [SD] age, 73.3…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 3,112 participants or records.
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